Late-Onset Diagnosis of Gestational Diabetes After Normal Mid-Pregnancy Screening in Women with Large for Gestational Age or Polyhydramnios: A Systematic Review and Meta-Analysis.
To determine the detection rate of late-onset gestational diabetes mellitus (GDM) and associated perinatal outcomes in women with normal mid-pregnancy glucose screening who undergo repeat oral glucose tolerance testing (OGTT) due to suspected large-for-gestational-age (LGA) fetuses or polyhydramnios.
We systematically searched PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library for studies published from January 2010 to November 2024.
We included cohort studies reporting late GDM detection rates in women with documented normal mid-pregnancy glucose testing (negative glucose challenge test or normal 75g OGTT at 24-28 weeks) who underwent repeat OGTT after 28 weeks due to sonographic findings of suspected LGA or polyhydramnios. We excluded studies of women with pre-existing diabetes, those lacking documented normal mid-pregnancy screening, and those examining routine late testing without specific clinical indication.
Study quality was assessed using the Newcastle-Ottawa Scale. Pooled detection rates with 95% confidence intervals were calculated using random-effects meta-analysis. Subgroup analyses were performed by clinical indication, timing of testing, initial screening method (two-step vs one-step), and maternal BMI. Perinatal outcomes were compared using pooled odds ratios calculated with the Mantel-Haenszel method.
Six cohort studies including 2,166 women met inclusion criteria. The pooled detection rate was 15.0% (95% CI: 9.9-21.0%; I2=91%). Detection rates varied significantly by indication: suspected LGA 20.8% (95% CI: 17.4-24.6%) vs. isolated polyhydramnios 4.8% (95% CI: 2.0-10.8%). Women with late-onset GDM had significantly higher rates of neonatal hypoglycemia (OR 1.82; 95% CI: 1.18-2.81), overall cesarean delivery (OR 2.00; 95% CI: 1.47-2.72), elective cesarean for LGA/macrosomia (OR 3.37; 95% CI: 2.01-5.64), emergent cesarean (OR 1.64; 95% CI: 1.05-2.57), and induction of labor (OR 2.27; 95% CI: 1.32-3.89). Macrosomia by birth weight and LGA at delivery were not significantly elevated.
Late OGTT detects GDM in approximately one in six women with normal mid-pregnancy screening who develop LGA or polyhydramnios. Late-onset GDM is associated with significantly increased neonatal hypoglycemia and cesarean delivery, with the largest effect for elective cesarean for suspected LGA/macrosomia. These findings may inform clinical decision-making regarding repeat glucose testing in the third trimester.
We systematically searched PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library for studies published from January 2010 to November 2024.
We included cohort studies reporting late GDM detection rates in women with documented normal mid-pregnancy glucose testing (negative glucose challenge test or normal 75g OGTT at 24-28 weeks) who underwent repeat OGTT after 28 weeks due to sonographic findings of suspected LGA or polyhydramnios. We excluded studies of women with pre-existing diabetes, those lacking documented normal mid-pregnancy screening, and those examining routine late testing without specific clinical indication.
Study quality was assessed using the Newcastle-Ottawa Scale. Pooled detection rates with 95% confidence intervals were calculated using random-effects meta-analysis. Subgroup analyses were performed by clinical indication, timing of testing, initial screening method (two-step vs one-step), and maternal BMI. Perinatal outcomes were compared using pooled odds ratios calculated with the Mantel-Haenszel method.
Six cohort studies including 2,166 women met inclusion criteria. The pooled detection rate was 15.0% (95% CI: 9.9-21.0%; I2=91%). Detection rates varied significantly by indication: suspected LGA 20.8% (95% CI: 17.4-24.6%) vs. isolated polyhydramnios 4.8% (95% CI: 2.0-10.8%). Women with late-onset GDM had significantly higher rates of neonatal hypoglycemia (OR 1.82; 95% CI: 1.18-2.81), overall cesarean delivery (OR 2.00; 95% CI: 1.47-2.72), elective cesarean for LGA/macrosomia (OR 3.37; 95% CI: 2.01-5.64), emergent cesarean (OR 1.64; 95% CI: 1.05-2.57), and induction of labor (OR 2.27; 95% CI: 1.32-3.89). Macrosomia by birth weight and LGA at delivery were not significantly elevated.
Late OGTT detects GDM in approximately one in six women with normal mid-pregnancy screening who develop LGA or polyhydramnios. Late-onset GDM is associated with significantly increased neonatal hypoglycemia and cesarean delivery, with the largest effect for elective cesarean for suspected LGA/macrosomia. These findings may inform clinical decision-making regarding repeat glucose testing in the third trimester.
Authors
Dominsky Dominsky, Berkovitz-Shperling Berkovitz-Shperling, Rosenberg-Fridman Rosenberg-Fridman, Gabbai Gabbai, Ram Ram, Yogev Yogev
View on Pubmed